Four-and-a-half years ago, doctors at Vanderbilt University Medical Center alerted state officials that the mother of a severely
ill infant might be making him sick. The state took custody of Phillip Patrick, but a month later, in
October 1996, he died.

Now Metro's medical examiner, Dr. Bruce Levy, has concluded there is no evidence of Munchausen syndrome by proxy, a rare
psychiatric disorder that causes a parent, usually the mother, to make a child sick to gain
attention.

''I do not believe that Phillip Patrick's death represents Munchausen Syndrome by Proxy,'' Levy wrote in his review of
the original autopsy report, written by another doctor. Instead, the 11-month-old Memphis boy's death resulted from multiple birth
defects, ''most notably those related to his gastrointestinal illness,'' he wrote.

''I didn't have any confidence in the way this case had been handled by the previous medical examiner,'' said Davidson County
District Attorney General Torry Johnson, who asked Levy to review the case about a year ago.

''We needed to see whether we had a case that needed to be investigated by the Police Department,'' Johnson said yesterday.
''As far as I'm concerned, no other action ought to be taken by our office or, for that matter, by the Police
Department.''

''I definitely feel I've been exonerated,'' said Phillip's mother, Julie
Patrick, who was never charged with any crime involving her son's
illness.

Patrick said she and her husband, Mark, who have three other children, will pursue a federal lawsuit they filed against Vanderbilt
in 1997, accusing doctors there of failing to control a serious infection Phillip had and of interfering in their ability to visit him
in the days before he died at the hospital.

According to Levy's report, Phillip was treated at several other hospitals for severe birth defects before he was admitted to
Vanderbilt on July 1, 1996. After treating him for ''multiple infections,'' doctors at Vanderbilt ''came to believe that Mrs.
Patrick might be responsible for Phillip's illnesses,'' and on Sept. 6, the state Department of Children's Services took custody of the
child.

''They retained custody of Phillip until his death (on Oct. 7), and the Patrick family was allowed only limited supervised visits with
him,'' Levy wrote.

Vanderbilt spokesman Joel Lee said Levy's report, which was completed Feb. 9, supports the medical center's position that its
staff acted properly and did not contribute to Patrick's death.

''There was evidence to suggest that Munchausen's could have been the diagnosis here,'' Lee said yesterday. ''We've got a legal
responsibility, when we have any reason to suspect child abuse, (to) report it.''

Levy wrote that the original autopsy and report, by then-acting medical examiner Dr. Miles Jones, was ''inadequate.'' He also
disputed Jones' conclusion that peritonitis, a serious gastrointestinal infection, was ''the underlying cause'' of Phillip's
death.

''We think the original autopsy was done in a manner that was unacceptable, to the detriment of both Vanderbilt and the
Patricks,'' Lee added. ''There are pieces of this case we may never know because the autopsy was so badly handled.''

Miles, who now works for a medical laboratory in Clayton, Ga., could not be reached for comment yesterday.

U.S. District Court Judge Robert Echols is considering a motion by Vanderbilt to dismiss the Patricks' lawsuit.

But Julie Patrick said she did not feel that Levy, who is a member of the Vanderbilt Medical School faculty, exonerated the medical
center in his report.

''The case against (Vanderbilt) is not simply malpractice,'' she said. ''It's outrageous conduct ... interference with the parent-child
relationship and conspiracy to defraud us of our parental relationship.''

In his report, Levy wrote that Julie Patrick's behavior ''fit the profile of a (Munchausen) perpetrator in some ways.''
''She was clearly pushy to the point of being obnoxious,'' he wrote. ''She frequently questioned the medical staff, their
conclusions and treatment options,'' and took Phillip to a succession of hospitals.

However, ''Phillip's condition did not improve in the absence of the mother,'' Levy wrote, as would be expected if she was making
him ill. ''Second, there is an adequate medical explanation for Phillip's medical course and death.''

Bill Snyder covers health for The Tennessean. He can be reached at 259-8226 or
bsnyder@tennessean.com.